Schoepfer Alain M, Safroneeva Ekaterina
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Inflamm Intest Dis. 2024 Jul 26;9(1):199-209. doi: 10.1159/000540275. eCollection 2024 Jan-Dec.
Eosinophilic esophagitis (EoE) is a chronic, food allergen-mediated, esophageal disease that will lead, if left untreated, to esophageal remodeling. As such, the vast majority of EoE patients need treatment. Treatment strategies include drugs, food elimination diets, and esophageal dilation. This review focuses on pharmacologic options for treatment of EoE.
Orodispersible budesonide tablets (Jorveza) have been approved by regulatory authorities for EoE treatment of adults in Europe, Canada, and Australia, but not in the USA. Jorveza, as compared to placebo, is effective in inducing and maintaining histologic and clinical remission over time. An orodispersible budesonide suspension (BOS, Eohilia) was recently approved in the USA as induction treatment (12 weeks) in adolescents of at least 11 years and adults with active EoE. Before the approval of Jorveza and Eohilia, several investigator-initiated randomized controlled clinical studies evaluated esophagus-targeted formulations of either budesonide or fluticasone to treat pediatric and adult EoE patients. These drugs were generally efficacious in inducing and maintaining histological and clinical remission. Proton-pump inhibitors (PPIs) are used off-label for EoE treatment of pediatric and adult EoE patients given that they are able to induce histologic and clinical remission. However, when compared to the moderate certainty of evidence with regard to the failure to achieve histologic remission with swallowed topical corticosteroids, the certainty of evidence for PPIs is very low with very inconsistent results in absolute terms. Dupilumab (Dupixent), a monoclonal antibody targeted against IL-4 and IL-13, was approved by regulatory authorities in the USA, Europe, Canada, but not yet Australia. In Europe, including Switzerland, Dupixent is approved to treat EoE patients of at least 12 years of age with at least 40 kg body weight if they are either unresponsive or intolerant to or not candidates for conventional EoE therapies. Due to lack of efficacy or unfavorable safety profile, the following drugs are not recommended for EoE treatment: systemic steroids, sodium cromoglycate, montelukast, azathioprine, TNF-antagonists (e.g., infliximab), vedolizumab (mAb against α4β7), benralizumab (mAb against IL-5 receptor), mepolizumab (mAb against IL-5), reslizumab (mAb against IL-5), omalizumab (mAb against IgE), and lirentelimab (mAb against Siglec-8).
Long-term effectiveness and safety data on different drugs are currently sparse. Concerted efforts of different stakeholders will be necessary to continue the endeavor of providing our patients with much-needed therapies.
嗜酸性食管炎（EoE）是一种慢性、食物过敏原介导的食管疾病，若不治疗会导致食管重塑。因此，绝大多数EoE患者需要治疗。治疗策略包括药物、食物排除饮食和食管扩张。本综述聚焦于EoE治疗的药物选择。
口腔崩解布地奈德片（Jorveza）已在欧洲、加拿大和澳大利亚获得监管机构批准用于成人EoE治疗，但在美国未获批。与安慰剂相比，Jorveza在诱导和维持组织学及临床缓解方面随时间推移是有效的。一种口腔崩解布地奈德混悬液（BOS，Eohilia）最近在美国被批准用于至少11岁的青少年和患有活动性EoE的成人的诱导治疗（12周）。在Jorveza和Eohilia获批之前，几项研究者发起的随机对照临床研究评估了布地奈德或氟替卡松的食管靶向制剂用于治疗儿童和成人EoE患者。这些药物在诱导和维持组织学及临床缓解方面通常是有效的。质子泵抑制剂（PPIs）被用于儿童和成人EoE患者的EoE治疗的非适应证用药，因为它们能够诱导组织学和临床缓解。然而，与吞咽局部用糖皮质激素未能实现组织学缓解的证据的中等确定性相比，PPIs的证据确定性非常低，绝对结果非常不一致。度普利尤单抗（Dupixent），一种靶向IL-4和IL-13的单克隆抗体，已在美国、欧洲、加拿大获得监管机构批准，但在澳大利亚尚未获批。在欧洲，包括瑞士，Dupixent被批准用于治疗至少12岁、体重至少40kg、对传统EoE疗法无反应或不耐受或不适合的EoE患者。由于缺乏疗效或安全性不佳，以下药物不推荐用于EoE治疗：全身用类固醇、色甘酸钠、孟鲁司特、硫唑嘌呤、TNF拮抗剂（如英夫利昔单抗）、维多珠单抗（抗α4β7的单克隆抗体）、贝那利珠单抗（抗IL-5受体的单克隆抗体）、美泊利珠单抗（抗IL-5的单克隆抗体）、瑞利珠单抗（抗IL-5的单克隆抗体）、奥马珠单抗（抗IgE的单克隆抗体）和利仑替利单抗（抗Siglec-8的单克隆抗体）。
目前不同药物的长期有效性和安全性数据稀少。不同利益相关者需要共同努力，继续为我们的患者提供急需的治疗方法。
